Hart Health Strategies provides a comprehensive policy briefing on a weekly basis. This in-depth health policy briefing is sent out at the beginning of each week. The health policy briefing recaps the previous week and previews the week ahead. It alerts clients to upcoming congressional hearings, newly introduced bills, regulatory announcements, and implementation activity related to the Patient Protection and Affordable Care Act (PPACA) and other health laws.


Alexander-Murray Stabilization Package Introduced

On Tuesday, October 17, Senate Health, Education, Labor, and Pensions (HELP) Committee Chairman Lamar Alexander (R-Tenn.) and Ranking Member Patty Murray (D-Wash.) announced that they had reached an initial agreement on a bipartisan package of legislation to stabilize the individual health insurance market. The deal would resume cost-sharing reduction (CSR) payments to insurers for two years and provide states with more flexibility to change Obamacare’s insurance regulations.

The Alexander-Murray health care plan is the culmination of three months of negotiations to provide a short-term fix for the rising premiums facing the individual market. Sen. Alexander hopes that the bill will stabilize premiums and provide Congress with more time to debate longer-term changes to the 2010 health care law. While the talks between Sens. Alexander and Murray stalled during last-ditch efforts to repeal and replace the Affordable Care Act (ACA) in September, the President’s recent announcement that he would immediately end CSR payments – which he characterized as a bailout of the insurance industry – provided the added pressure needed to complete negotiations.

Under the bill, States would be allowed to use existing section 1332 waivers to alter some of the ACA’s insurance parameters for policies offered on the Exchange. The agreement does not alter the current law coverage guardrails related to pre-existing conditions and essential health benefits (EHB). Current law requires “coverage that is at least as comprehensive” as ACA coverage offered through Exchange and requires “coverage to at least a comparable number of its residents.” Waivers could be used to approve insurance plans outside of Obamacare’s insurance regulations as long as they maintain the ACA’s coverage requirements and are of “comparable affordability” to plans in the current exchanges. Proposals are currently judged against a standard of “at least as affordable” as ACA coverage. The legislation would streamline and expedite the 1332 waiver application, shortening the federal waiver review period from 180 days to 90 days while also creating a 45-day emergency approval pathway. The maximum waiver period would be extended from five to six years, and state proposals would be scored over the life of the waiver, rather than during each individual year. States seeking a waiver that matches another state’s previously approved waiver would be automatically granted. The deal would also restore $106 million in Obamacare outreach and advertising funding to publicize the open enrollment period. President Trump had rescinded these funds earlier this year. The Alexander-Murray agreement would loosen the ACA’s limitations on catastrophic health insurance plans, also known as “copper plans.” These high-deductible plans are currently only available to people under the age of 30 or those who can demonstrate that purchasing a plan with more robust benefits would pose an economic hardship. This legislation would allow anyone to buy a copper plan, regardless of age or income level. Finally, the plan would require the U.S. Department of Health and Human Services (HHS) to issue regulations regarding health care choice compacts that would allow individuals to purchase coverage across state lines.

Democrats have appeared widely enthusiastic about the plan, which addresses their most immediate concerns about the affects of cutting off CSR payments. The deal also takes steps to reverse some recent actions from the Administration that Democrats believe were meant to undermine and “sabotage” the ACA. Republicans have been far more tentative in committing their support.

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